Pediatric Payment Corner – February 2019

(Continued)

By Rebecca H. Reddy, MD, FAAP

KDHE staff who implemented the change were unfamiliar with the complexity of EPSDT requirements per age and payment amounts per published CMS guidelines. They assumed a total payment for any KBH of $70, and divided this into all the services that could be provided, which explains the bewilderingly low payments for E and M codes around $25. This blunder was combined with Kancare MCO’s business motivation to profit within the Kancare system as well as a lack of qualified physician or medical administrator’s representation in making this decision, which resulted in the mess that you may find your office’s Kancare accounts receivables in at this time.

Rest assured this story has a happy ending. The KAAP provided KDHE staff with educational resources explaining actual payments to providers pre- and post- November 2018 as well as CMS recommended rates. Pediatric and family medicine practices all over the state contacted KDHD and alerted the Kansas AAFP and the KMS. Approximately 15 concerned pediatricians attended a Kancare Advsory Committee meeting on December 14 to protest the payment cuts. The director of KDHE, Jon Hamdorf, heard our testimony and decisively rescinded the payment changes made in Bulletin 18154, restoring payments for KBH’s to previous rates.

Kancare MCO’s were notified of this decision by KDHE on 12/17/18. They were given 60 days to effect this change, including reparations to practices for underpayments since 11/1/2018. Looking forward, the KAAP will continue working with the new administration in advocating for CMS parity for services provided to Kancare patients.

Your KAAP is at work for you. If your practice has a systemic payment problem, contact the KAAP pediatric council at pediatriccouncil@kaap.org.